1225028897 NPI number — GARY A SMITH ARNP

Table of content: GARY A SMITH ARNP (NPI 1225028897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225028897 NPI number — GARY A SMITH ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
GARY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225028897
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 636961
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-6961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-981-5130
Provider Business Mailing Address Fax Number:
513-981-5015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1710 HWY 121 N. BYPASS
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
MURRY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-226-1118
Provider Business Practice Location Address Fax Number:
270-226-1119
Provider Enumeration Date:
10/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  3003886 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 3003886 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000732995 . This is a "BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100157310 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00956479 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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